A few weeks ago I did an article about the series finale of my now-favorite television series, Mad Men. If you’ve seen the ending you know it closed with a somewhat cryptic scene that succeeded in doing the very best thing a series finale can ever do: keep people talking about what it means for a long time to come. As soon as I saw Mad Men’s ending I knew immediately I had to do another article on a similar series ending from a previous generation, and a previous much-beloved TV series that, unlike Mad Men, never quite got the respect or viewership it probably deserved. If you were around in the late 1980s you already know I’m talking about the famous and even more baffling conclusion of St. Elsewhere, the hospital drama series that in many ways paved the way for the very cerebral and envelope-pushing shows that we enjoy (on cable and video-on-demand) today, and which was undoubtedly the blueprint for Mad Men‘s head-scratching final scene.

St. Elsewhere, which ran on NBC from 1982 to 1988, was never a very popular show in terms of viewers, but it was consistently praised by critics and has endured as a significant cult object from the 80s. It was created by the same people behind Hill Street Blues and had the same format as an hour-long continuing drama with an ensemble cast. It concerned the travails of a South Boston hospital where richer hospitals dumped their indigent patients, hence the name. Big-time actors Denzel Washington and Bruce Greenwood got their start on the show, but St. Elsewhere also featured old-time Mercury Theater alum Norman Lloyd, comedian Howie Mandel, Robocop bad guy Ronny Cox and numerous other actors whose movie and TV careers span decades. One of the recurring characters was Dr. Donald Westphall, chief of surgery, played by Ed Flanders, who has an autistic son Tommy. The character of Tommy was played by child actor Chad Allen who later turned up on Star Trek: The Next Generation and Dr. Quinn: Medicine Woman, and who as an adult has become an activist for LGBT causes.

St. Elsewhere’s theme music was often confused with the theme from the movie St. Elmo’s Fire, which it resembled. Here you can see the acting talent assembled for the show.

On May 25, 1988, St. Elsewhere‘s last episode aired. The show went through the resolutions and goodbyes of various characters, with the last of them being Dr. Westphall sitting in the empty office of his friend, Daniel Auschlander (Lloyd) who has just died. Tommy is there, and snow flutters down outside. Then suddenly there’s an incongruous final scene in a working-class home in which Westphall appears to be a construction worker and Auschlander his father–a relationship never hinted anywhere else in the series. Tommy is consumed by sitting on the floor staring into the snow globe. The final “gag” you see in the above video: the snow globe contains a building resembling the hospital that was at the center of the show. The most common interpretation is that the entire series took place in Tommy Westphall’s imagination, a realm that, due to his severe autism, he cannot communicate to the outside world.

Before we get to the question of “what does it mean?”, which has been the perennial question about the finale for 27 years, it’s necessary to fill in some background. The 1988 finale, titled “The Last One,” wasn’t St. Elsewhere‘s first series finale–it was its second. Originally the show was to have been canceled at the end of the 1986-87 season, its fifth. The series finale involved the hospital being sold and closed down, the doctors transferred to other jobs, and a wrecking ball coming in and destroying the place–with, as a fluke, the mentally-addled Dr. Auschlander, inadvertently forgotten after a medical procedure, still inside. In fact this episode, called “Last Dance at the Wrecker’s Ball,” did air in May 1987. The producers had just learned that NBC reversed its decision and renewed the show for the next season, necessitating some significant changes to explain how the hospital is saved at the last moment. I think this is important, because for all intents and purposes, the producers and writers essentially got to do the series finale they really wanted in 1987. That they got another chance in 1988 was what we used to call in New Orleans a “lagniappe”–a pleasant unexpected extra.

real st. eligius

The Franklin Square House Apartments in Boston, built in the 1850s as the St. James Hotel, served as the exterior of “St. Eligius Hospital.” In the show the hospital was supposed to have been constructed in 1935.

I remember that at the time the finale sharply divided audiences and fans. One critic, I specifically recall, charged that the writers threw away the entire series on a “sophomoric joke.” Others found it funny, even brilliant. Many people chose to take it as it was probably intended: not a wholesale revision or repudiation of the entire St. Elsewhere series, similar to the dreadful cynicism of the “Bobby Ewing in the shower” finale on Dallas two years earlier, but a playful provocation that stood somewhat apart from the rest of the show. The 1987-88 season was pretty uneven as a whole, probably the weakest in St. Elsewhere‘s run, and after all the show had been unexpectedly rescued from cancellation, meaning all the story arcs had been wrapped up once at the end of the previous season. I think the writers felt a certain freedom to try the snow-globe ending that they might otherwise not have felt.

As a piece of metafictional storytelling, the snow-globe finale is a masterstroke. If you do adopt the literal approach, assuming that the whole show took place in Tommy Westphall’s head and only the final scene depicts the “real” world, you’re left grappling with a mind-bending array of concepts regarding orders of reality, hierarchies of universes and whether one person’s imagination is the “reality” of the people he/she imagines. These themes are exactly what I wrote about in my Giamotti trilogy, and in fact the ending of the third book, Giamotti in Winter, features a gag that I designed to resemble (structurally, at least) the St. Elsewhere ending. It’s worth stressing again that this is qualitatively different from Bobby Ewing in the shower, which was a clumsy attempt to erase an irrevocable story decision that the producers decided to reverse for purely commercial and not creative reasons. Dallas limped on for five more seasons after the “dream season.” St. Elsewhere ended with the snow globe, and at least nominally offered the viewers leeway to interpret it any way they wished.

book front

The ending of my 2009 novel Giamotti in Winter is, in part, an homage to the 1988 St. Elsewhere finale, in that it raises questions about whose “world” the story has taken place in.

One amusing theory I’ve heard about the snow-globe ending stems from the fact that St. Elsewhere often made in-jokes, references and outright crossovers to various other TV series. For example, in one episode doctors from the show’s St. Eligius hospital go get a drink at the bar from Cheers, and in another episode heart surgeon Dr. Craig mentions knowing B.J. Hunnicutt, a character from the sitcom M*A*S*H. The gag is that if St. Elsewhere takes place entirely in Tommy Westphall’s head, these other shows must as well. It’s not necessarily logical, but it’s an interesting premise.

For a two-minute scene aired on a low-rated television show, the St. Elsewhere finale raises some pretty interesting questions about the nature of fiction and its relationship to reality. Perhaps most remarkable is the fact that we’re still talking about them nearly 30 years later. What if we all do exist merely in the imagination of an autistic 8-year-old? Think about that the next time you look out the window and see it snowing.

Any/all imagery from St. Elsewhere is copyrighted by MTM Productions, the show’s production company. I believe my use of it here constitutes fair use under copyright law.